Imipenem with Cilastatin and Relebactam (Recarbrio®)
General Information
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Reserve'. All indications to be discussed with Micro/ID.
Renal and hepatic impairment
Renal impairment
|
Creatinine Clearance (mL/min) |
Recommended dosage of Recarbrio® (imipenem/cilastatin/relebactam) |
Frequency |
|
90 or over |
1250mg (500mg/500mg/250mg) |
Every 6 hours |
|
60-89 |
1000mg (400mg/400mg/200mg) |
Every 6 hours |
|
30-59 |
750mg (300mg/300mg/150mg) |
Every 6 hours |
|
15-29 |
500mg (200mg/200mg/100mg) |
Every 6 hours |
|
End stage renal disease (ESRD) on haemodialysis |
500mg (200mg/200mg/100mg) |
Every 6 hours (Administration should be timed to follow haemodialysis) |
|
Manufacturer advises that patients with creatinine clearance less than 15 mL/min should not receive Recarbrio® unless haemodialysis is instituted within 48 hours. |
||
Note: Dose ranges use creatinine clearance, rather than eGFR.
Patients with Creatinine clearance of 150 mL/min or more – discuss with pharmacy and Micro/ID
Hepatic impairment
No dosage adjustment required in hepatic impairment.
Pregnancy and breastfeeding
Pregnancy
Use only if benefits outweigh the risk in pregnancy
Breastfeeding
Discuss with pharmacy
Additional information
- Imipenem with cilastatin and relebactam 1.25g vial contains 500mg imipenem + 500mg cilastatin + 250mg relebactam
- There is a clinically significant interaction between carbapenems and sodium valproate or valproic acid which results in reduced valproate plasma concentrations with potential for inadequate seizure control. If patient is already prescribed sodium valproate or valproic acid and imipenem-cilastatin-relebactam is recommended discuss with Micro/ID and relevant medical team.
- Liver function should be closely monitored during treatment with Recarbrio®
- Each vial contains 37.5 mg of sodium (1.6 mmol), equivalent to 1.9% of the WHO (World Health Organization) recommended maximum daily intake of 2 g sodium for an adult. This should be considered when administering Recarbrio® to patients who are on a controlled sodium diet
References
- Merck Sharp & Dohme (UK) Limited. Summary of Product Characteristics (SPC). Recarbrio 500 mg/500 mg/250 mg powder for solution for infusion. Last revision of the text: May 2021. Accessed at https://www.medicines.org.uk/emc/product/11675 on 12/5/21